Role of ammonia in predicting the outcome of patients with acute-on-chronic liver failure

Table 2 Mortality analysis

Variable	Survivors, n (%) 411 (92.2)	Non-survivors, n (%) 35 (7.8)	P value
Age, median (IQR)	59 (50-65)	60 (49-66)	0.956
Male sex, n (%)	239 (58.2)	17 (48.6)	0.271
Albumin (g/dL), mean ± SD	2.4 ± 0.59	2.16 ± 0.5	0.022
Bilirubin (mg/dL), median (IQR)	2.33 (1.37-4.67)	3.52 (1.93-6.49)	0.013
INR, median (IQR)	1.45 (1.27-1.68)	1.81 (1.5-2.6)	0.005
Creatinine (mg/dL), median (IQR)	0.82 (0.63-1.26)	0.77 (0.62-1.32)	0.397
Platelets (× 109/L), median (IQR)	132 (92-180)	123 (82-173)	0.481
WBC (× 109/L), median (IQR)	7.24 (5.37-9.89)	11.04 (6.79-13.45)	0.014
CRP (mg/dL), median (IQR)	1.36 (0.8-2.98)	3.15 (1.7-4.67)	0.001
Venous ammonia (μmol/L), median (IQR)	100 (75-139)	198 (125-345)	< 0.001
Venous ammonia > 152.5 μmol/L, n (%)	75 (19)	24 (70.6)	< 0.001
Sodium (mmol/L), median (IQR)	134 (130-137)	133 (130-137)	0.215
Child-Pugh score, median (IQR)	11 (10-12)	13 (11-15)	< 0.001
Child-Pugh score ≥ 12.5	58 (14.4)	19 (57.6)	< 0.001
Child-Pugh class, n (%)
A	3 (0.7)	0
B	84 (20.8)	0
C	317 (78.5)	33 (100)
MELD score, mean ± SD	18.43 ± 6.26	27.31 ± 7.37	< 0.001
MELD score ≥ 22.5	119 (29)	27 (77.1)	< 0.001
AARC score, median (IQR)	7 (6-8)	9 (9-11)	< 0.001
AARC score ≥ 8.5	42 (10.2)	26 (74.3)	< 0.001
ACLF, n (%)
Grade I	291 (70.8)	5(14.3)
Grade II	117 (28.5)	22 (62.9)
Grade III	3 (0.7)	8(22.9)
Ascites, n (%)	376 (91.5)	32 (91.4)	0.991
HE, n (%)	341 (83)	33 (94.3)	0.081
Grade I	126 (37)	1 (3)
Grade II	135 (39.6)	4 (12.1)
Grade III	76 (22.3)	12 (36.4)
Grade IV	4 (1.2)	16 (48.5)
Grade I or II HE, n (%)	261 (76.5)	5 (15.2)	< 0.001
Grade III or IV HE, n (%)	80 (23.5)	84.8 (28)
Upper GI bleeding, n (%)	82 (20)	7 (21.2)	0.862
SBP, n (%)	22 (5.4)	2 (5.9)	0.705
Other infections, n (%)	63 (15.3)	7 (20)	0.466
AKI, n (%)	39 (9.5)	13 (38.1)	< 0.001
HCC, n (%)	9 (2.2)	2 (5.7)	0.211
Hospital stay (d), median (IQR)	8 (6-11)	5 (3-10)	0.160

IQR: Interquartile range; SD: Standard deviation; INR: International normalized ratio; WBC: White blood cells; CRP: C-reactive protein; MELD: Model for end-stage liver disease; AARC score: APASL ACLF Research Consortium score; HE: Hepatic encephalopathy; GI: Gastrointestinal; AKI: Acute kidney injury; SBP: Spontaneous bacterial peritonitis; HCC: Hepatocellular carcinoma.